Blog Post Title One

Energetic Healing Session Intake Form

Personal Information

• Name:

• Date of Birth:

• Email Address:

• Phone Number:

• Preferred Contact Method:

  • Email

  • Phone

  • Text

Health & Wellness Background

1. Have you received energetic healing before?

   • Yes

   • No

2. If yes, what type of energy healing have you experienced?

3. What are your primary reasons for seeking an energetic healing session? (Please check all that apply)

   • Stress relief

   • Emotional healing

   • Physical pain

   • Spiritual growth

   • Other (please specify):

4. Are there any specific areas of concern or conditions you would like to address during the session?

5. Do you have any known allergies, medical conditions, or mental health concerns that we should be aware of?

6. Are you currently taking any medications or supplements?

   • Yes (please specify):

   • No

Energetic Preferences

1. Are there specific types of crystals or healing modalities you are drawn to?

2. Do you have any preferences for the type of session? (e.g., distance healing, in-person, group, individual)

3. Is there anything else you would like us to know to create the best healing experience for you?

Consent

• By signing this form, I acknowledge that I am seeking energetic healing as a complementary therapy and not as a substitute for medical advice or treatment.

Signature:
Date:

Thank you for taking the time to complete this intake form. We look forward to guiding you on your healing journey at Traveler's Moon.